LETTER TO EDITOR
Year : 2019 | Volume
: 5 | Issue : 1 | Page : 71--72
Revisiting the underemphasized advantages of apprenticeship in light of competency-based medical education
V Dinesh Kumar
Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
V Dinesh Kumar
Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
|How to cite this article:|
Kumar V D. Revisiting the underemphasized advantages of apprenticeship in light of competency-based medical education.J Curr Res Sci Med 2019;5:71-72
|How to cite this URL:|
Kumar V D. Revisiting the underemphasized advantages of apprenticeship in light of competency-based medical education. J Curr Res Sci Med [serial online] 2019 [cited 2020 Jun 2 ];5:71-72
Available from: http://www.jcrsmed.org/text.asp?2019/5/1/71/260631
Clinical teaching, in most of the Indian Medical Colleges, has been working on the principles of the Halstedian master-apprenticeship model, which is more of an opportunity-based learning approach. For example, a student posted in surgery may get opportunities to witness and assist a variety of cases ranging from simple excision of cyst to complex surgeries based on chance. In the apprenticeship model, student initially becomes familiar with common medical problems, legitimately participates in a peripheral manner, performs under supervision, and finally perform independently. The main drawback of this model is that it is difficult to ascertain whether students have gained satisfactory level of surgical acumen at the end of postings and moreover, mere observation might not help them in reaching the desired level of expertise. Particularly, in countries like India, where significant variations exist in the number and types of cases during clinical posting, the efficacy of master-apprenticeship model differs based on the case load and faculty:student ratio. However, we could not deny the fact that the immersive experience provided by this model has motivated a significant proportion of students to choose the specialty as future career.
In order to achieve equitable and satisfactory level of competency among medical graduates, the concept of entrustable professional activities (EPAs) was proposed. The deficiency in the apprenticeship model, i.e., the uncertainty whether all graduates are capable of performing specific tasks could be addressed by means of EPAs. The critiques of competency-based medical education often lament about the fact that the rigid checklist-oriented training would break the immersive experience of learning into small junks at the cost of authenticity. At this context, we are left with two questions as follows: (1) Are we keen on focusing on proximal needs and compromise on flexibility needed for facing a more uncertain professional future? and (2) Are we going to miss out a few domain independent competencies which are specific for particular disciplines?
For answering thefirst question, we need to reiterate certain positives which are conferred by the master-apprenticeship model in clinical workplace learning. The flexibility, in terms of pursuing individual interests and goals, could be afforded to students by aiding them using the principles of communities of practice. By following this, students can be grouped for apprenticeship or stewardship programs in different departments and can be given chances to explore beyond the stipulated competencies. Von Bodegom et al. stated that students' clinical acumen gets remodeled in master-apprentice relationship when they enter the “hidden curriculum” of the workplace. Based on this, they put forth that the apprenticeship model, if executed rigorously, would serve as a potential method for teaching the skills of critical thinking, listening, questioning, and framing arguments. In other words, these are few attributes which might get lost when clinical teaching is subjected to the reductionist process.
Workplace learning, during apprenticeship, cannot be stereotyped as mere learning and reproduction of skills. In addition, the learner acquires “tacit knowledge” through informal interaction with peers and masters. These “tacit” components of medical education constitute the domain independent competencies which are usually learned through interaction between two or more individuals or groups. Considering the fact that, in the healthcare profession, the responsibility of putting the learned things together while providing patient care is the sole responsibility of the learner, we could enunciate the value of skills being learnt in social settings.
To conclude, the pendulum of education swings between reductionism, where the continuum of learning an individual specialty is broken down into nested units and holism, in which the students are subjected to immersive clinical experience. The former offers the benefit of facilitating every medical graduate to achieve satisfactory level of competencies, whereas the success of later one depends on the reflection and self-regulation of the student. Amalgamating the benefits of both school of thoughts might yield significant benefits to the learner. Therefore, we plea the educators to introspect on the underemphasized advantages of apprenticeship model such as clerkship postings and retain them. In addition, newer modalities such as communities of practice should be implemented for facilitating the individual interests of students.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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